Tibet is the province with the largest international rivers and water resource reserves in China. However, due to its special ecological environment, the utilization of water resources has become an inevitable problem. Considering the undesirable outputs in water resource utilization, the Super-efficiency Slack-based Measure (SE-SBM) model is used to measure water utilization efficiency of Tibet and the Tibetan areas (four provinces where Tibetan areas are located) from 2006 to 2016. The mixed and random panel Tobit model is used to investigate the driving factors of water efficiency and a horizontal comparison between provinces is made on this basis. The results show that the water utilization efficiency of Tibet and the Tibetan areas in four provinces shows a "U-shaped" trend. The water utilization efficiency of most provinces is greater than or close to 1 and the water utilization efficiency of each province shows a constant convergence trend. Environmental regulation and technological innovation have a significant positive effect on water utilization efficiency. Urbanization and foreign direct investment (FDI) have a significant negative effect on water utilization efficiency. Per capita Gross Domestic Product (GDP) and water resource endowment have no significant effect on water utilization efficiency. It is necessary to select a new type of urbanization suitable for the Tibetan Plateau, eliminate the backward production capacity, high water consumption, or high emissions industries, and to strengthen the research and development of water-saving and emission-reduction technology innovation in Tibet.Sustainability 2019, 11, 3396 2 of 11 10,000 CNY of industrial output was as high as 173.53 cubic meters, which was 3.78 times the national average. The per capita water consumption is 949.6 cubic meters per person, ranking second in China. Due to the special geography of the Tibet Autonomous Region, water resource utilization is not only the core issue of the coordinated development between people and nature in Tibetan areas, but also affects major strategic issues such as sustainable development, cross-border ecological security, and biodiversity conservation in China and neighboring countries [3,4]. Improving water utilization efficiency of associated sectors such as agriculture, industry, and residential consumption is considered to be one potential solution to the water scarcity problem [5,6].Faced with the increasingly severe water resources situation, water utilization efficiency has attracted more and more attention from the academic community. The research objects include agricultural irrigation, industrial enterprises, key cities, etc. The research methods also involve the stochastic frontier method, the data envelopment analysis method, principal component analysis, etc. [7,8]. Ding et al., and Sun et al., considered the undesirable output evaluation of water utilization efficiency in the production process and found that the water utilization efficiency of various provinces and regions in China showed ...